Radiation exposure to patients during ERCP is significantly higher with low-volume endoscopists》.pdf

ORIGINAL ARTICLE: Clinical Endoscopy Radiation exposure to patients during ERCP is significantly higher with low-volume endoscopists Charles Liao, MD,* Nirav Thosani, MD, MHA,* Shivangi Kothari, MD, Shai Friedland, MD, Ann Chen, MD, Subhas Banerjee, MD Stanford, California, USA Background: Patients are exposed to radiation during ERCP, and this may increase their lifetime risk of the development of cancer and other deleterious radiation effects. Objective: To evaluate the association between the endoscopist’s ERCP volume and the patient radiation dose during ERCP. Design: Single-center, retrospective study. Setting: Tertiary referral center. Patients and Interventions: A total of 197 patients undergoing 331 ERCPs. Main Outcome Measurements: Patient radiation exposure parameters including fluoroscopy time, total radia- tion dose, dose area product, and effective dose for all ERCPs performed at our academic medical center by 2 high-volume endoscopists (HVEs) ( R200 ERCPs/year) and 7 low-volume endoscopists (LVEs). Radiation exposure for each ERCP was adjusted against a validated procedure complexity scale and the Stanford Fluoroscopy Complexity Score, which was created based on the numbers of interventions that would mandate additional radiation exposure. Results: ERCPs performed by LVEs were associated with a significantly higher median total radiation dose (98.30 mGy vs 74.13 mGy), dose area product (13.98 Gy-cm2 2 vs 8.8 Gy-cm ), and effective dose (3.63 mSv vs 2.28 mSv), despite lower median Stanford Fluoroscopy Complexity Scores (3.0 vs 6.0) compared with HVEs. No significant diff